COMPLAINTS RESOLUTION PROCESS. FAIS Ombudsman & Client Complaints

Transcription

1 COMPLAINTS RESOLUTION PROCESS FAIS Ombudsman & Client Complaints

2 Contents COMPLAINTS PROCESS Introduction Capture and assign Acknowledge Assessment / Investigation Determination Finding Analysis Complaints Resolution Department

3 1 Introduction Complaints dealt with under this category relate to advise rendered by representatives linked to Momentum Consult (Pty) Ltd - FSP license The following process is the sequence of events followed in order to obtain resolution of Category E complaints: 2 Capture and assign The Complaints Resolution Officer (hereinafter referred to as the CRO) will receive a complaint (from either the client, an internal department which received the complaint, or the FAIS Ombudsman). In the case of a client complaint, the client must complete a formal Momentum Consult complaints form, wherein all allegations against the representative will be listed. In some instances, where the client s allegations are clearly set out in an / letter we would not request the completion of the complaints form. In other instances we receive telephonic complaints which we reduce to writing and request confirmation of the conversation so that all aspects of the complaints are recorded and investigated. The client s written complaint / Ombudsman s request must be logged in a database where it will be kept for a period of not less than five years. The CRO must open a client complaint file wherein all documents relating to this complaint will be filed. 3 Acknowledge The CRO, on receipt of a client complaint will acknowledge the complaint to the client within 1 working day. In the acknowledgement the CRO will communicate a due date when a response will be provided to the client. In the case of an Ombudsman complaint, the Ombudsman will provide a date when the matter should be finalized and responded to. The Ombudsman allows 14 days for complaints which was previously send to Momentum Consult by the client and 6 weeks for new complaints send to the Ombudsman directly. 4 Assessment / Investigation The CRO must send a composite mail containing the complaint and related documents- 4.1 in the case of Momentum Consult Employee Benefits, to the Principal Consultant and Regional Manager copying the Head of Momentum Consult Employee Benefits and the Compliance Officer; and 3

4 4.2 in the case of Momentum Consult Wealth and Retail, to the related Franchise Principal, the Momentum Consult Wealth or Retail Manager and copying the Compliance Officer. The allegations contained in the complaint must be investigated and the representative implicated in the client complaint, must be afforded the opportunity to respond to these allegations and provide a statement in answer to the allegations along with all supporting compliance documentation or relating documentation. The relevant manager must ensure that the representative responds within 2 days. Should the representative not respond within 48 hours, the CRO must escalate this matter to the relevant Head of business. 5 Determination The complaints resolution panel (hereinafter referred to as the CRP) must meet at a monthly complaints panel meeting at which meeting the CRO will present on proposed resolves for complaint matters which the panel is encouraged to debate and discuss. A meeting pack for each complaint containing updated information will be circulated on the shared folder at least 48 hours before the meeting. Should the complaints resolution panel require an independent compliance/advise opinion the CRO will liaise with the relevant forum to obtain such opinion and revert to the CRP to make an informed decision. 6 Finding The CRP will make a decision on each matter based on the information presented and make a decision to: 6.1 Repudiate: Advice client and Ombud in formal response with supporting documentation. In the case of a client complaint, where such complaint is not resolved to the client s satisfaction, such client must be given the Ombudsman s details. 6.2 Hold representative accountable for client loss; Inform representative, relevant manager, Head of business and CRO (in the instance where debarment is recommended). Depending on severity of the representative s actions or inaction the representative must receive a written warning from relevant manager. CRO informs the relevant Product House to reverse commission. 4

5 CRO informs Head of Debit Management of the findings and that commission has been reversed to the representative s commission account and Head of Debit Management to have representative sign Debit Loan to recover debt. The Representative may claim from PI cover Written warning needs to be given to representative by the relevant manager as required by Marsh. Payments to clients: Business has a Fraud and Loss account which covers the amount payable to the client. The Head of Debit Management gets advised of this and proceeds legally to recover money. The recovered money to be allocated back to business fraud and loss account. 6.3 Product house accountability: The CRO will liaise with the Product House to convey findings of the panel to the Legal advisor/compliance/complaints officer to investigate. The relevant persons to inform Head of product house and follow up on payment to client from the Product House. 6.4 Settlement with client and recovery (Fraud and Loss process): In the case of a settlement, same will only be executed in instances that gave rise to a financial loss. Prior to settlement it first needs to be established whether the description of the loss falls within the Personal indemnity (PI cover) claims structure for possible payment to the client and/or recovery for loss paid to a client from a fraud and loss account. In the event of a PI cover claim, the claim will be lodged with the insurer by the Finance Department; the Head of business will also be involved in the process. The Fraud and Loss claim form must be completed by the CRO and signed by the Head of business and submitted to the CRO. The CRO will then review the form follow up on any outstanding requirements/information and obtain the signature of the relevant authorized person as mentioned in the Fraud and Loss document. CRO will thereafter forward the form to the Finance Department along with a synopsis of the complaint attached. 5

6 6.5 Appeal process Should the representative not be satisfied with the outcome of the decision by either the Ombud or CRP, the representative has the option to appeal the process. The appeal process will include outside parties to review the matter and provide the representative the opportunity to either sit in or provide a statement forming the basis of his appeal 7 Analysis The CRO will analyze complaints received, based on the misconduct of the representative and categorize the complaints according to: 7.1 Misrepresentation is constituted by representatives misrepresenting a certain type of policy to the client and/or disclosures on commission earned by them and include the following: Fraudulent activity by the representative relates to representatives who committed fraud to benefit themselves, negatively affecting the client financially. Non-disclosure by the clients relates to matters where the clients did not disclose pre- existing medical conditions of either Health or Life policies. Negligence by Representative relates to a representative mistakenly cancelling a client s policy. Lack of knowledge by client relates to clients not understanding the products chosen by them or by the representative on their behalf as best suited. Clients with endowments who query the endowment term, clients in preservation funds who requested more than one withdrawal, clients with RA s requesting withdrawals. 7.2 Syndication relates to Sharemax, Realcor, Pickvest and Blue Steel Property Investments. 7.3 Advice dispensed under other FSP relates to complaints where the intermediary is a broker under a different FSP than the 5503 license. 7.4 Non Advice related complaints are constituted by complaints relating to administrative queries including wrongful premium deductions, alterations, claim rejections by Product House and Odyssey related queries/complaints. 7.5 Appropriateness of advice relates to matters where the relevance of the policy for the client is questioned. 6

7 7.6 Process breakdowns (includes re -inter mediation process) relates to matters where clients were either not notified of being reinter mediated or requested change of an intermediary. 7.7 Unprofessional behavior from representative relates to a matter where a representative acted unprofessional in the sense of being rude to the client and her circumstances. 7.8 Acting outside ambit relates to representatives requesting payment from clients for presentation of the various products Momentum has to offer and not being taken up by the client. 7.9 Performance relates to clients complaints where clients question the growth on their investments- Wealth Products / investments where pay out to the client was questioned in terms of the exchange rate. Replacement relates to policies where a replacement of a client s previous policy was effected and didn t perform as well as the replaced product Replacement relates to policies replaced from other Product Providers for example: PPS, Old Mutual, Liberty, Sanlam, Discovery etc Leads Acquisition relates to representatives obtaining client information and calling clients to advise on Momentum products. The CRO will prepare a trend analysis based on the complaint categories and representatives involved to identify risk areas. 8 Complaints Resolution Department Complete the Momentum Consult Complaint form, attach all relevant documents and return to the address below: Contact person: The Complaints Resolution Officer Postal address: PO Box 7400 Centurion 0046 Physical address: 268 West Avenue Centurion 0157 Tel: +27 (0) Fax: clientcomplaints@momentum.co.za 7